Controversies in Critical Care: Glycemic Control

Abstract

The pertinent perioperative issue of glucose control in known diabetics and in patients who exhibit stressinduced hyperglycemia is the focus of this chapter. With 8.3% of the population of the United States (approximately 26 million individuals) suffering from diabetes mellitus, the issue of glycemic control in the perioperative period will be encountered by every US anesthesiologist. The vast majority (more than 90%) of these patients suffer from a type of diabetes that results from inadequate production of insulin, lack of responsiveness to the insulin produced, or excessive gluconeogenesis; a combination of these factors may also be present. Evidence-based medicine (EBM) can help guide management. The evidence currently available and limitations of its application during the perioperative period will be reviewed, including the basis for the evidence supporting clinical recommendations and areas where additional research and data may be needed. The risks imposed by inadvertent hypoglycemia will be discussed and will provide a framework to address current controversies that clinicians face when attempting to optimize the care of patients with perioperative hyperglycemia based on EBM (Supplemental Digital Content 1, http://links.lww.com/ ASA/A497).